BREAST CYTOPATHOLOGY

154 6. Breast Ductal Lavage
Table 6.1. Nipple aspiration fluid cytology and breast cancer:
prospective evaluation of nipple aspiration fluid in 2,343 women,
with average follow-up of 12.7 years.
Women with breast
Cytologic cancer/women Percent with Adjusted
diagnosis with same diagnosis breast cancer relative risk
No breast fluid 9/352 2.6 1.0
Unsatisfactory 15/315 4.8 1.4
Normal 56/1,291 4.3 1.8
Hyperplasia 18/327 5.5 2.5
Atypical 6/58 10.3 4.9
hyperplasia
Total 104/2,343 4.4
Low volume, paucity of epithelial cells, and abundance of
degenerative changes constitute limitations to the use of
NAF. Ductal lavage has been developed to obviate these
problems.
Ductal lavage (DL) is a minimally invasive procedure that
allows in vivo sampling of the ductal epithelium. A microcatheter
is inserted in a fluid-yielding nipple duct, followed
by lavage with 10–20 mL of saline solution in 2- to 4-mL
increments; the lavage fluid is then collected, and the cytology
of the epithelial cells is examined. In a study comparing NAF
and DL samples obtained from a cohort of 507 women at
high risk of breast cancer, DL yielded samples with greater
number of ductal cells than NAF (Table 6.2). In the
same study, both NAF and DL identified two patients with
Table 6.2. Characteristics of samples obtained by nipple fluid aspiration
and ductal lavage.
Nipple aspiration
Ductal lavage
fluid (417 women)
(383 women)
Epithelial cells/duct 120 (Range 10–74,300) 13,500 (Range 43–492,000)
Satisfactory samples 27% 78%
Mild atypia 27 (6%) 66 (17%)
Marked atypia 12 (3%) 24 (6%)
Malignant 2 (<1%) 2 (<1%)